Health scare 'clouded views on HRT'

17:30Monday 21 May 2012

"Thousands of women have had a ‘wasted decade’ of suffering since the HRT scare, according to an international panel of experts,” the Daily Mail has reported.

The news is based on a major re-evaluation of the Women’s Health Initiative (WHI) study, the results of which prompted safety fears in 2002. The re-analysis comes in a series of journal reports which were highly critical of the way the results of the WHI were presented and the media’s interpretation of them. The reports said this led to panic based on scant real-life evidence, which may have caused a change in prescribing practice to the potential detriment of the wellbeing of thousands of women worldwide.

The authors of one review concluded: “While HRT is certainly not appropriate for every woman, it may be for those with symptoms or other indications. In that setting, with initiation near menopause, the weight of evidence supports benefits over risks.”

Hormone replacement therapy (HRT) is a treatment used to relieve the symptoms of menopause. It replaces the female sex hormones that women’s bodies stop producing after menopause. Reduced production of the hormone oestrogen is associated with many of the symptoms of menopause, including:

HRT replaces this hormone, reducing these symptoms. HRT comes in different forms – some are taken continuously and some are taken with breaks in between – as a tablet, patch, implant, gel or cream. Most HRT preparations contain an oestrogen in combination with a progestogen. The kind of HRT a woman is prescribed will be based on her individual circumstances. For more information, see the NHS Choices information on HRT.

Safety concerns over long-term use of HRT significantly altered medical thinking on prescribing it, prompted by the initial results of two large trials. These were the US Women’s Health Initiative (WHI) study (published in 2002), part of which was halted early because women using HRT were seen to be at higher risk of breast cancer, and the UK Million Women Study (published in 2003), which also showed a higher rate of breast cancer in women on HRT.

The authors of the new re-analysis said that the scare, which led to a significant drop in prescribing HRT, was not helped by how the science was portrayed worldwide in the media. They were especially critical of the reporting of relative risks (a 26% increase in breast cancer risk) rather than “excess” or “attributable” risk of four extra breast cancer cases per 1,000 women taking HRT over a five-year period. The authors also criticised the dramatic nature of the press releases about the research issued by the Journal of the American Medical Association and the US National Heart, Lung and Blood Institute. They argued that this gave rise to the health scare that sparked the widespread avoidance of HRT.

A decade after the release of the results of the WHI study, the peer-reviewed journal Climacteric has published an entire issue re-appraising the evidence from the WHI study and other evidence published in the last 10 years.

One of the Climacteric articles stated that the WHI study was designed to address whether older women (much older than the average age for menopause, which in the UK is 52) who mostly did not have symptoms of menopause, benefitted from HRT. However, they authors said the results were generalised to all women, and this in combination with the fact that a 26% relative risk increase in breast cancer was reported (rather than a modest increase in absolute risk) led to the HRT scare.

Other aspects of HRT’s effect on women’s health were examined, including:

In the new study looking at breast cancer and HRT, the authors concluded that the benefits of HRT in women with low initial risk of breast cancer and significant menopausal symptoms will outweigh the harms, because their absolute risk of cancer is low.

One analysis that looked at the rates of HRT use found that it had dropped by between 40% and 80%. The positive or negative effects of this decline on disease and death rates have not yet been assessed. A 2011 statement from the International Menopause Society, quoted in the re-analysis, said that the media presentation of the WHI results in 2002 engendered “excessive conservatism” that “has disadvantaged nearly a decade of women who may have unnecessarily suffered severe menopausal symptoms and who may have missed the potential therapeutic window to reduce their future cardiovascular, fracture and dementia risk”.

An analysis of the media’s role in the HRT scare found that the common perception of HRT as risky continued until July 2007, when the trial revised its findings on cardiovascular risk. However, they reported that the media portrayed this revision as a “U-turn” by experts (including on the front page of the Daily Mail), reinforcing the media’s “confused interpretation” of the safety and benefits of HRT. However, the authors said that the “melodramatic presentation” of the WHI results explained the media response.

Like any drug or treatment, HRT is associated with both risks and benefits. However, according to NICE in 2009, the overall balance of benefits and side effects suggests that HRT is acceptably safe and beneficial enough to justify its use for certain women experiencing severe problems during menopause. This is not to say it is risk-free or suitable for the majority of women, but it does have justified uses.

In the report in question, the authors stated that the International Menopause Society recommends individualised treatment, with age being taken into account as a safety issue. HRT shows the most benefits for women with symptoms who start HRT within a few years of menopause, and therefore as women get older the potential risks of HRT may outweigh the diminishing benefit offered.

The authors of one review concluded: “While HRT is certainly not appropriate for every woman, it may be for those with symptoms or other indications. In that setting, with initiation near menopause, the weight of evidence supports benefits over risks”.

Doctors would assess whether or not HRT was an appropriate treatment on a case-by-case basis. They would take into account factors such as the severity of a woman’s symptoms and whether she has a history of breast cancer (certain types of breast tumour can be encouraged by female hormones).

The findings of this new research do not in themselves suggest that HRT should be offered more widely, but they certainly raise some interesting points over the need for a clear, evidence-based approach to assessing HRT and also in the way perceptions of danger have affected its use. They open the door to further robust research re-evaluating HRT, which needs to be performed and judged in as objective a manner as possible.

This website and its associated newspaper adheres to the Independent Press Standards Organisation's Editors' Code of Practice.
If you have a complaint about editorial content which relates to inaccuracy or intrusion, then contact the
Editor by clicking here.

If you remain dissatisfied with the response provided then you can contact the IPSO by
clicking here.

Ulster Star provides news, events and sport features from the Lisburn area. For the best up to date information relating to Lisburn and the surrounding areas visit us at Ulster Star regularly or bookmark this page.

For you to enjoy all the features of this website Ulster Star requires permission to use cookies.

Find Out More ▼

What is a Cookie?

What is a Flash Cookie?

Can I opt out of receiving Cookies?

About our Cookies

Cookies are small data files which are sent to your browser (Internet Explorer, Firefox, Chrome etc) from a website you visit. They are stored on your electronic device.

This is a type of cookie which is collected by Adobe Flash media player (it is also called a Local Shared Object) - a piece of software you may already have on your electronic device to help you watch online videos and listen to podcasts.

Yes there are a number of options available, you can set your browser either to reject all cookies, to allow only "trusted" sites to set them, or to only accept them from the site you are currently on.

However, please note - if you block/delete all cookies, some features of our websites, such as remembering your login details, or the site branding for your local newspaper may not function as a result.

The types of cookies we, our ad network and technology partners use are listed below:

Revenue Science ►

A tool used by some of our advertisers to target adverts to you based on pages you have visited in the past. To opt out of this type of targeting you can visit the 'Your Online Choices' website by clicking here.

Google Ads ►

Our sites contain advertising from Google; these use cookies to ensure you get adverts relevant to you. You can tailor the type of ads you receive by visiting here or to opt out of this type of targeting you can visit the 'Your Online Choices' website by clicking here.

Digital Analytics ►

This is used to help us identify unique visitors to our websites. This data is anonymous and we cannot use this to uniquely identify individuals and their usage of the sites.

Dart for Publishers ►

This comes from our ad serving technology and is used to track how many times you have seen a particular ad on our sites, so that you don't just see one advert but an even spread. This information is not used by us for any other type of audience recording or monitoring.

ComScore ►

ComScore monitor and externally verify our site traffic data for use within the advertising industry. Any data collected is anonymous statistical data and cannot be traced back to an individual.

Local Targeting ►

Our Classified websites (Photos, Motors, Jobs and Property Today) use cookies to ensure you get the correct local newspaper branding and content when you visit them. These cookies store no personally identifiable information.

Grapeshot ►

We use Grapeshot as a contextual targeting technology, allowing us to create custom groups of stories outside out of our usual site navigation. Grapeshot stores the categories of story you have been exposed to. Their privacy policy and opt out option can be accessed here.

Subscriptions Online ►

Our partner for Newspaper subscriptions online stores data from the forms you complete in these to increase the usability of the site and enhance user experience.

Add This ►

Add This provides the social networking widget found in many of our pages. This widget gives you the tools to bookmark our websites, blog, share, tweet and email our content to a friend.